Campus Outreach South Africa (COSA) began in 2003, when a team of 24 American missionaries from Christ Covenant Church (CCC) in Charlotte, North Carolina, partnered with local South African churches to launch an interdenominational campus ministry across Gauteng's universities.

In 2012, oversight of the ministry transitioned from CCC to Central Baptist Church (CBC) in Pretoria, and it was renamed Campus Outreach Gauteng. From 2012 to March 2020, the ministry operated under the joint authority of CCC and CBC.

When a long-term agreement between CCC and CBC could not be reached, CCC partnered with several local South African churches to establish a sustainable, locally-governed model for raising up labourers for the lost world on campus.

This process led to the formation of Campus Outreach South Africa NPC on 25 February 2021 — a ministry governed by a board of local South African churches, working together to build university campus movements under local church authority.